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l APPL'lC ION FOR SANITATION PERMIT Permit No. ---1.-� ---- _r '- -.(Complete,in Duplicate) �' Date Issued - --.' -- /f-'F_-- This Permit Expires 1 Year From Date Issued .: -_- "`•r,pplicat 6n is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS 55 A OCATION.. 'C-- "�t / 7 - - Owner's Name ------ Phone._'/ --- ,,77 - ...... -- t Address r -------------------------------- ----- ---- y- .�.�- - ------------- - one.. -- ------•------------------ --------- Phone ,�-�/Ali � actors Name--.--- -- ----- �------ p----- - - - --- -- ' "�Contr l-e Installation will serve: Residence Apartment House ❑ Commercial Trailer Cou t ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths __-. o size -------- --------------------- Water,Supply n -system ❑ Community system ❑ Private [Depth to Water Table/_::97 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe [�Hardpari ❑ Previous Application Made: (If yes,date____________________l No El New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.] r nce from nearest well L_�_ Distance from foundation_____- ____.____Mater al- ------ -- - ----------------------- Sep0tiVc --------- Septic Tnh: Dista , No. of compartments----rk--------------Size.L/_�1Z- Liquid depth----, ----------Capacity_f 24 d- - Disposal Id: Distance from nearest well_.r7�-------Distance from foundation--- 5_ -----Distance to nearest lot line_S_____---_ Number of lines-------�---- ----yyyy-----------Length of each line------ Q- --i---.Width of trench_.�?_y------------------- Type of filter material-_--'.....1 <_Depth of filter materia r .._ ---- length____________________ 0--------• Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line.___-________--__ t7� Number of pits- - ------------------Lining material------ --------------- Size: Diameter-----------------------Deptn....----------------------------- 0 foundation material.._________-_______.___._.___-._____. J Cesspool: Distance from nearest well-----------------Distance from ❑ Size: Diameter-_- --------------- --------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------_--------------_------------- _.Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line------ - --------------- --------------------------------------------------------------- ---- G Remodeling and/or repairing (describe)------------------------- ---------------------------------------------- - ------ . 40 ----------I-------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------•---------------------------------------------------------••---------------------------------- -------- d -- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Uate ,laws, and rules an regulations of the an Joaquin Local Health District. -- --- ----------------------- - -- ------------------- ---- - - {Signed]------------------- -- ---�r and/or Contract wn d/o or) - ------{Title] - - ----------------- - - ----- -------- BY-- ----------------- --- g p (Plot plan, showing size of ot, location of system in r afion to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- DATE----------------------------- - --------------------------- ---=--- ------------ ---------- REVIEWEDBY----- --------------------------------- DATE----------- ------•-•----------------------------------- BUILDINGPERMIT ISSUED---------------------------- ------------------------------ ----------------- DATE------------------------------------------------------------ Alterations and/or recommendations-------------------- ----- ------------------------------------------------------------------------ ------- -------------------------- I ------ ---- FINAL,INSPECTION BY:....- --- Date. " _ �'� ------------------ ---- -- t SAN.JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave: 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California IF.P.CO.